High-dose ramipril in cardiovascular prevention Review article
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Published:
Jun 30, 2017
Keywords:
ramipril, angiotensin converting enzyme inhibitors, pleiotropic effect, cardiovascular prevention
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Abstract
This review is focused on data suggesting marked cardiovascular benefits of full-dose (10 mg/24 h) ramipril regimen. Available clinical data confirming the efficacy and safety of ramipril 10 mg are summarized. Of special interest, data from large scale HOPE trial and its subanalyses suggest pleiotropic protective effects beyond mere antihypertensive efficacy, resulting in reduced risk of acute cardiac conditions, new diagnosis of diabetes and its complications, as well as improved overall survival.
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Kupczyńska, K., & Kasprzak , J. D. (2017). High-dose ramipril in cardiovascular prevention. Medycyna Faktow (J EBM), 10(2(35), 86-92. Retrieved from https://journalsmededu.pl/index.php/jebm/article/view/2143
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References
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14. Heart Outcomes Prevention Evaluation Study Investigators: Effects of ramipril on cardiovascular and microvascular outcomes in people with diabetes mellitus: results of the HOPE study and MICRO-HOPE substudy. Lancet 2000; 355: 253-259.
15. Marre M., Lievre M., Chatellier G. et al.; DIABHYCAR Study Investigators: Effects of low dose ramipril on cardiovascular and renal outcomes in patients with type 2 diabetes and raised excretion of urinary albumin: randomised, double blind, placebo controlled trial (the DIABHYCAR study). BMJ 2004; 328: 495.
16. The GISEN Group (Gruppo Italiano di Studi Epidemiologici in Nefrologia): Randomised placebo-controlled trial of effect of ramipril on decline in glomerular filtration rate and risk of terminal renal failure in proteinuric, non-diabetic nephropathy. Lancet 1997; 349: 1857-1863.
17. Ruggenenti P., Perna A., Gherardi G. et al.: Renal function and requirement for dialysis in chronic nephropathy patients on long-term ramipril: REIN follow-up trial. Gruppo Italiano di Studi Epidemiologici in Nefrologia (GISEN). Ramipril Efficacy in Nephropathy. Lancet 1998; 352: 1252-1256.
18. Aggarwal N., Kare P.K., Varshney P. et al.: Role of angiotensin converting enzyme and angiotensinogen gene polymorphisms in angiotensin converting enzyme inhibitor-mediated antiproteinuric action in type 2 diabetic nephropathy patients. World J. Diabetes 2017; 8: 112-119.
19. Aikawa Y., Rohde L., Plehn J. et al.: Regional wall stress predicts ventricular remodeling after anteroseptal myocardial infarction in the Healing and Early Afterload Reducing Trial (HEART): an echocardiography-based structural analysis. Am. Heart J. 2001; 141: 234-242.
20. Mathew J., Sleight P., Lonn E. et al.; Heart Outcomes Prevention Evaluation (HOPE) Investigators: Reduction of cardiovascular risk by regression of electrocardiographic markers of left ventricular hypertrophy by the angiotensin-converting enzyme inhibitor ramipril. Circulation 2001; 104: 1615-1621.
21. Willoughby S.R., Rajendran S., Chan W.P. et al.: Ramipril sensitizes platelets to nitric oxide: implications for therapy in high-risk patients. J. Am. Coll. Cardiol. 2012; 60: 887-894.
22. Goyal D., Chong A.Y., Watson R.L. et al.: Assessment of single versus twice daily dosing of ramipril by ambulatory blood pressure monitoring in patients similar to those included in the HOPE study. J. Hum. Hypertens. 2007; 21: 525-530.
2. Burnier M., Brunner H.R.: Angiotensin II receptor antagonists. Lancet 2000; 355: 637-645.
3. Lonn E.M., Yusuf S., Jha P. et al.: Emerging role of angiotensin-converting enzyme inhibitors in cardiac and vascular protection. Circulation 1994; 90: 2056-2069.
4. Sharpe N., Smith H., Murphy J. et al.: Early prevention of left ventricular dysfunction after myocardial infarction with angiotensin-convertin-enzyme inhibition. Lancet 1991; 337: 872-876.
5. Piepoli M.F., Hoes A.W., Agewall S. et al.; Authors/Task Force Members: 2016 European Guidelines on cardiovascular disease prevention in clinical practice: The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts) Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). Eur. Heart J. 2016; 37: 2315-2381.
6. Ponikowski P., Voors A.A., Anker S.D. et al.; Authors/Task Force Members: 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur. J. Heart. Fail. 2016; 18: 891-975.
7. Windecker S., Kolh P., Alfonso F. et al.; Authors/Task Force members: 2014 ESC/EACTS Guidelines on myocardial revascularization: The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS) Developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur. Heart J. 2014; 35: 2541-2619.
8. Yusuf S., Sleight P., Pogue J. et al.: Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients: the Heart Outcomes Prevention Evaluation Study Investigators. N. Engl. J. Med. 2000; 342: 145-153.
9. Dagenais G.R., Yusuf S., Bourassa M.G. et al.; HOPE Investigators: Effects of ramipril on coronary events in high-risk persons: results of the Heart Outcomes Prevention Evaluation Study. Circulation 2001; 104: 522-526.
10. Teo K.K., Mitchell L.B., Pogue J. et al.; HOPE Investigators: Effect of ramipril in reducing sudden deaths and nonfatal cardiac arrests in high-risk individuals without heart failure or left ventricular dysfunction. Circulation 2004; 110: 1413-1417.
11. Bosch J., Lonn E., Pogue J. et al.; HOPE/HOPE-TOO Study Investigators: Long-term effects of ramipril on cardiovascular events and on diabetes: results of the HOPE study extension. Circulation 2005; 11: 1339-1346.
12. Yusuf S., Teo K.K., Pogue J. et al.; ONTARGET Investigators: Telmisartan, ramipril, or both in patients at high risk for vascular events. N. Engl. J. Med. 2008; 358: 1547-1559.
13. Lonn E., Yusuf S., Dzavik V. et al; SECURE Investigators: Effects of ramipril and vitamin E on atherosclerosis: the study to evaluate carotid ultrasound changes in patients treated with ramipril and vitamin E (SECURE). Circulation 2001; 103: 919-925.
14. Heart Outcomes Prevention Evaluation Study Investigators: Effects of ramipril on cardiovascular and microvascular outcomes in people with diabetes mellitus: results of the HOPE study and MICRO-HOPE substudy. Lancet 2000; 355: 253-259.
15. Marre M., Lievre M., Chatellier G. et al.; DIABHYCAR Study Investigators: Effects of low dose ramipril on cardiovascular and renal outcomes in patients with type 2 diabetes and raised excretion of urinary albumin: randomised, double blind, placebo controlled trial (the DIABHYCAR study). BMJ 2004; 328: 495.
16. The GISEN Group (Gruppo Italiano di Studi Epidemiologici in Nefrologia): Randomised placebo-controlled trial of effect of ramipril on decline in glomerular filtration rate and risk of terminal renal failure in proteinuric, non-diabetic nephropathy. Lancet 1997; 349: 1857-1863.
17. Ruggenenti P., Perna A., Gherardi G. et al.: Renal function and requirement for dialysis in chronic nephropathy patients on long-term ramipril: REIN follow-up trial. Gruppo Italiano di Studi Epidemiologici in Nefrologia (GISEN). Ramipril Efficacy in Nephropathy. Lancet 1998; 352: 1252-1256.
18. Aggarwal N., Kare P.K., Varshney P. et al.: Role of angiotensin converting enzyme and angiotensinogen gene polymorphisms in angiotensin converting enzyme inhibitor-mediated antiproteinuric action in type 2 diabetic nephropathy patients. World J. Diabetes 2017; 8: 112-119.
19. Aikawa Y., Rohde L., Plehn J. et al.: Regional wall stress predicts ventricular remodeling after anteroseptal myocardial infarction in the Healing and Early Afterload Reducing Trial (HEART): an echocardiography-based structural analysis. Am. Heart J. 2001; 141: 234-242.
20. Mathew J., Sleight P., Lonn E. et al.; Heart Outcomes Prevention Evaluation (HOPE) Investigators: Reduction of cardiovascular risk by regression of electrocardiographic markers of left ventricular hypertrophy by the angiotensin-converting enzyme inhibitor ramipril. Circulation 2001; 104: 1615-1621.
21. Willoughby S.R., Rajendran S., Chan W.P. et al.: Ramipril sensitizes platelets to nitric oxide: implications for therapy in high-risk patients. J. Am. Coll. Cardiol. 2012; 60: 887-894.
22. Goyal D., Chong A.Y., Watson R.L. et al.: Assessment of single versus twice daily dosing of ramipril by ambulatory blood pressure monitoring in patients similar to those included in the HOPE study. J. Hum. Hypertens. 2007; 21: 525-530.